The effects of physical activity and body mass index on cardiovascular, cancer and all-cause mortality among 47 212 middle-aged Finnish men and women

Abstract

OBJECTIVE:To examine the association of physical activity and body mass index (BMI), and their combined effect, with the risk of total, cardiovascular disease (CVD) and cancer mortality. DESIGN: Prospective follow-up study. SUBJECTS: In all, 22 528 men and 24 684 women aged 25-64 y at baseline having 7394 deaths during a mean follow-up of 17.7 y. MEASUREMENT: A self-administered questionnaire data on smoking, socioeconomic factors, physical activity and medical history, together with measured height, weight, blood pressure and serum cholesterol using standardized protocol. RESULT: Physically active subjects had significantly lower age-adjusted mortality from cardiovascular, cancer and all causes compared with sedentary ones. Further adjustment for smoking, systolic blood pressure, cholesterol, BMI, diabetes and education affected the results only slightly. Obese subjects (BMIZ30 kg/m 2 ) had significantly higher cardiovascular and total mortality than the normal weight (18.5rBMIo25 kg/m 2 ) subjects. Part of increased mortality among obese subjects was mediated through obesity-related cardiovascular risk factors. BMI had an inverse association with cancer mortality among men and almost significant direct association among women. Total mortality was also increased among the lean (BMIo18.5 kg/m 2 ) subjects. However, less than 0.3% of deaths were attributed to low body weight, whereas in men 5.5% and in women 17.7% of deaths were attributed to obesity. CONCLUSION: Regular physical activity and normal weight are both important indicators for a decreased risk of mortality from all causes, CVD and cancer. Physical activity had a strong independent effect on mortality, whereas the effect of BMI was partly mediated through other obesity-related risk factors.

Association between domains of physical activity and all-cause, cardiovascular and cancer mortality

“…Previous studies have hypothesized that high physical activity may attenuate the increased risk of mortality that is related to adiposity [16,31]. In our population sample, the beneficial effects of physical activity on mortality seem to be present in non-obese men and women (BMI<30) only.…”

“…Some population studies and reviews detected a reduced risk of cancer mortality through enhanced physical activity among men [25], women [11] or both sexes [16,17,26,27], but none of them has independently examined work, transportation, household and leisure time physical activity. A large prospective follow-up study from Finland [16] reported a 21% and 27% lower risk of cancer mortality for men and women, respectively, when comparing high versus low occupational and leisure time physical activity. With regard to our study sample, moderately active individuals almost halved their risk of premature deaths due to cancer, while vigorously active persons reduced their risk by almost two thirds.…”

“…Especially household physical activity in relation to mortality has not been given sufficient attention; the distinct effect of regular housework in terms of all-cause and CVD mortality has only recently been investigated [12,15]. In addition, few population-based data exist on different types and intensities of activity undertaken during daily routines and their relation to cause-specific mortality [11,16,17]. These considerations, and the insufficient prior systematic investigation of physical activity, subdivided into different domains, on all-cause, CVD and cancer mortality in a population-based cohort, were the motivation for this study.…”

The effect of diabetes and stroke at baseline and during follow-up on stroke mortality

“…Since questions on alcohol consumption were different between the first two surveys (1972 and 1977) and the latter surveys, the participants were categorised as either abstainers or alcohol users. Physical activity included occupational, commuting and leisure-time physical activity, and results were merged and regrouped into three categories: low, moderate and high [27][28][29][30][31][32][33][34]. At the study site, specially trained research nurses measured blood pressure, height and weight using a standardised protocol [26].…”

Effects of physical activity, body mass index, waist-to-hip ratio and waist circumference on total mortality risk in the Swedish National March Cohort

“…It has been proposed that physical activity could counteract the risk of obesity. Physical activity has been shown to weaken, but not eliminate the heightened risk associated with excess weight [15,34,35]. However, many studies to date measure only one component of total activity, such as leisure time or occupational physical activity, which may not be a true representation of actual total physical activity.…”